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Prodigy > apex > Flashcards

apex Flashcards

1
Q

what is increased in the serum of the patient with renal osteodystrophy

A

2 p’s
phosphate and parathyroid

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2
Q

what is produced by the kidney

A

erythropoietin
renin

not antidiureitc hormone or angiotensin II

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3
Q

where is angiotensinogen produced

A

liver

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4
Q

where is angiotensin I produced

A

systemic circulation

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5
Q

what does a bun to creatine ratio of 30 suggest

A

inc bun/ cr ratio (> 10:1)
upper gi bleed
dehydration
inc protein intake
obstructive uropathy

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6
Q

creatine clearance

A

normal = 95-150
mild = 50-80
mod dysfxn= 10-25
severe dysxn <10

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7
Q

calculate gfr for a male

A

(140-age) x wt kg / (serum cr x72)

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8
Q

gfr calculation for a women

A

0.85 x ((140-age) x wt kg/ serum creatine x 72))

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9
Q

how does vasopressin increase gfr

A

constrict efferent

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10
Q

what tells concentrating ability of the kidney?

A

creatine clearance and fractional excretion of sodium

tubular fxn is measured by concentrating ability

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11
Q

what labs are liekly to be abnormal with ESRD

A

hgb and bleeding time

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12
Q

staging kidney dz

A

stage 1- inc cr 50% or uo < 0.5 ml/kg/hr for 6 hrs
stage 2- inc 100% or for 12 hrs
stage 3- inc 200% or for <0.3 for 24 hrs

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13
Q

what are causes of prerenal azotemia

A

chf, abd compartment syndrome, aortic artery clamping

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14
Q

intrarenal azotemia causes

A

acute tubular necrosis
vasculitis
intersitial nephritis
acute glomerulonephritis

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15
Q

best way for renal protect after major muscle trauma

A

mannitol

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16
Q

complications of sevo to pt with renal dysfunction

A

fluoride and compound A

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17
Q

what drugs cause hypokalemia (u waves)

A

bumetanide
metolazone

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18
Q

what diuretic worsens hyperkalemia

A

hydrochlorothiazide

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19
Q

what diuretic should be avoided in diabetic patient

A

hydrochlorothiazide- thiazide diuretics cause hyperglycemia

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20
Q

what diuretics cause ototoxicity

A

furosemide
ethacrynic acid

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21
Q

what kind of diureitc is indapimide

A

thiazide diuretic

inhibits na-cl transporter in distal tubule- dec reabsorption of na, cl, bicarb and water

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22
Q

what is mannitol likely to cause

A

hypoNa
pulmonary edema

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23
Q

where is the portal v located

A

between splanchnic circulation and liver

basin of blood leaving spleen, intestine, stomach, gallbladder and pancreas

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24
Q

what supplies 25% of liver blood flow

A

hepatic a. also supplies 50% of oxygen

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25
Q

how does propranolol reduce hepatic blood flow?

A

hepatic a. constriction

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26
Q

what part of liver is most susceptible to hypoxic injury

A

zone 3- near central vein- recieve the least amount of oxygen- most susceptible to hypoxic injury

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27
Q

most common cause of viral hepatitis

A

A

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28
Q

hepatitis msot likely to be transitted during a blood transfusion

A

b and c

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29
Q

most significant risks for halothane hepatitis

A

obesity and age > 40
femle; genetic predisposition; induction of cyp3e1 (alcohol, isoniazid, phenobarbital)

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30
Q

physiologic changes that accompany liver failure

A

restrictive pulm defect, thrombocytopenia

failing liver cannot clear endogenous vasodilators (VIP, glucagon) - it decreases response to vasopressors

31
Q

what is used in child pugh score

A

albumin, pt, bilirubin, ascites, encephalopathy

32
Q

what happens with cirrhosis

A

cell death- healthy hepatic tissue is replaced by nodules and fibrotic tissue- reduces number of functional hepatocytes and sinusoids

number of blood vessels in liver is reduced- inc hepatic vascular resistance- portal htn

causes ascites, hepatomegaly, splenomegaly, peripheral edema, esophogeal varices

33
Q

how do you tx hepatorenal syndrom

A

liver transplant

34
Q

management for pt with bleeding esophogeal varices

A

TIPs, propranolol

35
Q

alcohol withdrawl syndrome is tx with

A

BB (for tachycardia), benzo (sedation), a2 agonist (ans hyperactivity), alcohol

disulfiram- used as a part of alochol abstinence program- not for acute withdrawl

36
Q

what comes from adrenal cortex

A

alosterone-> sodium reabsorption

37
Q

what comes from adrenal medulla

A

inc epi and NE-> systemic vasoconstriction

38
Q

what comes from atrium

A

natriuresis

39
Q

what comes from post pit gland

A

inc antidiuretic hormone- aquaporin synthesis and insertion in renal collecting ducts

40
Q

what should be avoided in hyperthyroid

A

levothyroxine

41
Q

when does glucosuria happen

A

> 180 mg/dL

42
Q

what is expected with acromegaly

A

-oversecretion of growth hormone after adolescence
-large tongue (macroglossia) and epiglottis
-subglottic narrowing along vocal cord enlargement
-turbinate enlargement
-OSA

43
Q

etiologies of addisons

A

autoimmune (most common in US)
adrenal tumor
TB (most common worldwide)
dm1
trauma
hiv
hitt

44
Q

what should you avoid in someone with thyroid storm

A

amiodarone

45
Q

what should you not give with hypercalcemia

A

LR- b/c it contains calcium

46
Q

which of the following is true?
1. an excess causes muscle wasting
2. mineralcorticoid acitvity inc serum glucose
3. it engages w receptors on cell membrane
4. it inhibits insulin release

A

1

cortisol is a glucocorticoid- raises serum glucose through gluconeogenesis

also has some mineralcorticoid proterties - leads to na retention , k secretion, h secretion (think aldosterone)

it does not interact with membrane bound receptors- delayed onset of action

47
Q

drug class of glipizide

A

sulfonylurea

48
Q

drug class of pioglitazone

A

thiazoilidinedione

49
Q

drug class of exenatide

A

glp 1 agonist

50
Q

complications of conns syndrome

A

hypokalemia and htn

51
Q

insulin in shortest to longest acting

A

humalog, humulin R, humulin N, lantus

52
Q

what do you give if carcinoid syndrome becomes hotn

A

somatostatin (octeotide or lanreotide)- inhibits release of vasoactive substances from carcinoid tumors

53
Q

graves disease has inc or dec T4/ TSH

A

graves= hyperthyroid
inc free T4
dec TSH

54
Q

s/s of graves disease

A

insomnia
protein catabolism and wt loss
expothalmos
anxiety
ht intolerance

55
Q

steroid potency compared to cortisol: aldosterone, methylprednisone, fludrocortisone, decadron

A

aldosterone 0x
methylprednisone 5x
fludrocortisone 10x
decadron 25x

56
Q

what is the cause of endemic goiter

A

iodine deficiency

57
Q

addisons disease symptoms

A

hyponatremia
hyperpigmentation
hyperk
severe hypovolemia (na and cl wasting)
shock like state from decreased co
death within 3d- 2weeks

decrease mineralcorticoid (aldosterone) production; decreases glucocorticoid (cortisol) production
-surgery, sepsis, trauma poorly toelrated- can elad to death

58
Q

what increases growth hormone secretion

A

stress, anxiety, surgery
physiologic sleep
hypoglycemia
dec free fatty acid levels
inc blood amino acid levels
fasting
dopamine
alpha adrenergic agonists
estrogen

not corticosteroids or pregnancy

59
Q

hyperthryoid anesthesia considerations

A

-even mild no elective procedures unless euthyroid
-inc sensitivity to muscle relaxants
-mac unchanged
-higher risk of corneal abrasion
-bb good
-inc risk for pathologic fractures during positionign

60
Q

cv changes accompanying a normal pregnancy include increased

A

HR, sv, plasma volume

dbp decreases
sbp unchanged

61
Q

a pregnant mom has hx of mitral stenosis. when is greatest risk of hemodynamic compromise?

A

third stage of labor

62
Q

what are the effects of progesterone?

A

decreased mac, decreased paco2, increased sensitivity to LA

63
Q

side effects of beta agonist therapy for preterm labor

A

maternal hypokalemia, hyperglycemia, tachycardia

64
Q

what LA is least likely to undergo fetal ion trappign

A

chloroprocaine

65
Q

fetal bradycardia is a common complication of which block

A

paracervical

66
Q

when is the best time to perform non obstetric surgery on pregant patient

A

2nd trimester

67
Q

cardiovascular complications of chronic maternal cocaine abuse include all the following except

A

anemia

68
Q

what is youngest pca for surgery

A

60 weeks

69
Q

what are most reliable indicators of recovery in neonate

A

max insp force better than -25
flexion of knees to chest

neonates will not follow commands

70
Q

what is not an acute tx for postintubation laryngeal edema:
-nebulized racemic epi
-heliox
-cool and humidified oxygen
-decadron 0.5 mg/kg iv

A

-decadron

71
Q

what congenital heart defects are associated with ventricular outflow obstruction?

A

tetralogy of fallot
pulmonary stenosis with ASD

72
Q

can you use nasopharyngeal airways with cleft lip/ palate

A

yes

73
Q
A

Prodigy (4 decks)

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